She was the towns leading heroin dealer. She was 19 years old

In West Virginia, a young woman and a privileged physician lived very different lives. But they shared a crushing addiction

Breanne McUlty knew about Dr Rajan Masih long before she met him.

McUlty was still a teenager, hooked on whiskey and methamphetamine and soon to be dealing heroin, when she first heard about the doctor. Masih was a respected, prosperous family man running a hospital emergency room.

But McUlty knew from those of her friends who preferred to get high on painkillers effectively heroin in a legal pill that Masih was the go-to doctor for illicit opioid prescriptions in Grant County, West Virginia.

Everybody knew him as pretty much the top drug dealer around here, said McUlty Maybe he got greedy. Everybody makes mistakes just like I did. Hes a decent person now, trying to make up for it.

But Masih was more than a dealer. The doctor was also hooked on the pills he was feeding to other opioid addicts.

The lives of the privileged physician and the young woman whose upbringing set her on the path to addiction and selling hard drugs while she was still a child eventually crossed after each was freed from years in prison. They shared a parole officer who drug tested them, and approved where they lived and worked. They also shared a belief that incarceration saved them from early deaths.

Arrest was the best thing that could have happened to me because I could not and I would not stop, said Masih. It was a downward spiral and I would have died.

McUlty was 25 when she finally returned to her home town of Petersburg, the capital of Grant County, two years ago. Masih was 51 when he was released a few months earlier, stripped of his licence to practice medicine and with little idea what his future held in the struggling rural town of about 2,500 people.

Freedom from prison and drugs gave the two former inmates clearer perspectives on the epidemic that has hit their state harder than any other. It has by far the highest overdose death rate in the country at double the national average. Opioids kill more West Virginians than guns and car accidents combined.

The crisis reaches across generations, from former coal miners to students, although doctors increasingly notice a trend among the young to go straight to heroin whereas many older people come at it through prescription opioids.

In their own ways, McUlty and Masih determined to do what they could to combat the epidemic they contributed to. But they have been daunted by the scale of the challenge.

I came home from prison thinking I was going to make a difference. Im going to help all these people, said McUlty. Because Im different now theyre going to see that they can be different too. It was a slap in the face when everybody was: Screw you. You think youre better than us now. I think everybody accepted their fate. Nobody really wants help. The people I really want to get to, they just turn their heads. They say: Im not that bad off. I can stop when I want to stop.

Breanne McUlty talks to Mary Sue Connolly, who is making a documentary film about the opioids crisis in West Virginia.

I just wanted to be free

Masih, who was born in Chicago and is married to a former police officer, was working as an emergency room doctor a decade ago when he crashed a racing car and hurt his back. He self-medicated with samples of an opioid painkiller, hydrocodone.

It was unbelievable. Not only did it take my pain away but I immediately felt this is amazing. I like my job. I like talking to people. Im not irritated and angry with patients all the time, he said.

When the samples ran dry, Masih wrote fake prescriptions in the names of his mother, wife and children.

After a few months I crossed that line where if I dont have pills every four to six hours Im in withdrawal. I have no energy. Everything hurts. I cant think straight. Just getting more pills would immediately bring me back to my new normal, he said.

Masih was well aware of the danger of addiction and conducted ultrasounds on his own liver to check for damage. But he kept taking the pills even as they left him ever more physically and emotionally detached from his family of five children.

I wanted my life back. Id look at people sitting on their porch, playing with their kids. Here I am obsessed with getting my next pills and staving off withdrawal. I was caught in this trap. I just wanted to be free, he said.

Drug companies were pouring opioids into West Virginia, delivering 780m painkillers into a state of just 1.8m people over a five year period to 2012, according to an investigation by the Charleston Gazette-Mail.

Demand grew in part out of the physical toll of coal mining. Miners long used moonshine, marijuana and prescription pills to cope with the stresses and pain of work underground. But there had never been anything like the hydrocodone and oxycodone flooding onto the market in the 1990s. They were so effective and easy to get that miners often passed them out among themselves. Few were told how addictive these drugs were.

Before long, opioids were so widely prescribed doctors noted rising addiction among people who had taken them to deal with relatively minor conditions such as broken bones. The drugs were in so many bathroom cabinets that word spread among young people looking to experiment that opioids provided a powerful high. The pills began to displace meth amphetamine which had long been used as inoculation against the struggles of life in marginalised communities.

Drugs like oxycodone, hydrocodone, they treat all kinds of pain, said Masih. The pain of being a single mom looking after a kid. The pain of that person who doesnt have a job. The pain of, Im 20 years old, nobody cares. The pain of being bullied. The pain of Im gay. It treats all of those pains. Its less about physical pain. Its more about this social angst of there are no jobs. The economys crushed. This is a state thats been marginalised in so many ways. Drugs are a solution to that.

Opioids proved by far the most deadly.

Things fall apart

By the time Masih sank into addiction, McUlty was dealing in drugs even though she was barely in her teens.

She remembers her father using cocaine and meth amphetamine, and drinking heavily. Then he branched into prescription opioids. He couldnt get out of bed without them, she said.

Eventually the abuse to his body put him in hospital in a coma.

Her mother left, taking her younger sister. McUlty describes struggling to find food in the house but said there was a steady stream of users and dealers passing through.

Breanne McUlty, a former addict and heroin dealer who went to prison, pictured with her mother during a prison visit. Photograph: Chris McGreal for the Guardian

Drugs were so much part of the daily routine that when someone asked the 15 year-old to sell a bit of morphine it seemed a natural thing to do. Before long she was dealing regularly. By then, McUlty was also regularly drinking liquor.

McUltys father confirmed her description of his dependence on drugs and alcohol, and the part it played in pushing his daughter along the path of dealing and addiction.Although Petersburg is a small town, she managed to avoid arrest for drugs but was convicted of stealing a pair of shoes. She was also expelled from school for disruption.

At 16 she was pregnant. By then McUlty was homeless. I was on probation. Some anonymous call said I was pregnant and I was walking the streets. Sometimes I was barefoot and looked helpless I guess. My dad was driving by one day and saw me and said Youve got a court order and gave me the papers, she said.

The court made McUlty agree to move into a shelter for teenage mothers but she soon fled to Maryland where her daughter was born. Then she returned to Petersburg and slipped back into the old routine. I really didnt think there was a different way. I thought it was always going to be like that, she said.

For a while, the important thing for McUlty was to hang on to her daughter and she got back together with her daughters father. But things quickly began to unravel. Her boyfriend was a heavy drug user and they fought a lot. McUlty moved in with her grandparents but was desperate for money so she started selling crystal meth.

She went to a party and woke in a cupboard with no memory of the previous few hours but certain she had been raped. It never occurred to her to call the police. Instead she fell back on crystal meth.

It gives you a lot of energy but after a while your mental health starts floating away. You get really really thin. It eats away at your teeth. It messes with your brain. You start imagining things. Hallucinating. You hate it but cant stop, she said.

Salvation for Masih came from a pharmacist who called the Drug Enforcement Administration (DEA) with suspicions about his prescribing. Armed DEA agents arrested him at the emergency room.

They asked me questions about an individual who overdosed on medications I prescribed. This individual died. They asked me: Did you write these prescriptions?. I said: Yes I did, he said.

A DEA agent testified that of the 16 people who died from opioid overdoses in the area in the two years before Masihs arrest, three were his patients. Masih prescribed one of them hundreds of opioid pills, far above recommended dosages, immediately before the mans death. He also prescribed the fentanyl patches that killed a woman.

Masih faced 136 charges but reached a plea deal admitting a single count of illegally supplying opioids to a patient he knew to be injecting them. The doctor was jailed for four years and lost his medical licence.

I think I got a very fair deal out of the whole thing, he said. I 100% accept responsibility for what happened to me.

Many in Petersburg speak highly of Masih. Hundreds of people signed an online petition praising him as a doctor and calling for his release. Others are more sceptical, including the county sheriff who regards Masih as guilty of more than he was convicted of but said the former doctor turned his life around and is respected in the town.

Masih says he prescribed recklessly but not intentionally.

Recklessly to me means my barometer is off because I just took six hydrocodone and obviously this is not a sane decision making process, he said.

Does he feel responsibility for the deaths?

I dont. I realise that many people became addicted to drugs or dependent on drugs as a result of me. I believe that people may have overdosed on medications that I prescribed. But these were people who already had been on narcotics for years through other doctors. I basically continued to do what their physicians had prescribed for them, he said.